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Perioperative Patient Blood Management (excluding obstetrics): Guidelines from the French National Authority for Health.

Anaesthesia, critical care & pain medicine
October 1, 2024
Alexandre Theissen et al. (19 authors)
Journal ArticlePractice GuidelineHuman StudyClinical
Study Details

Study Goal

The researchers aimed to summarize the French National Authority for Health (HAS) guidelines on patient blood management (PBM) in surgical procedures, focusing on optimizing iron use to manage anemia and reduce transfusions.

Results Summary

The guidelines recommend detecting and correcting iron deficiency preoperatively, using intravenous iron postoperatively for anemia management, and adopting restrictive transfusion thresholds to improve patient outcomes and reduce hospital stays.

Population

Surgical patients, particularly those with moderate to high bleeding risk or preoperative anemia.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
detecting anemia and iron deficiency and taking corrective measures well in advance of surgery
neutral
anemia and iron deficiency
patients with moderate to high bleeding risk or known preoperative anemia
-
recommended
#1
use of tranexamic acid
decrease
bleeding
patients with high bleeding risk or in case of hemorrhage
-
recommended to limit bleeding
#2
use of cell salvage
neutral
-
patients undergoing some surgeries with a major risk of transfusion
-
recommended
#3
limitation of blood samples
decrease
blood samples
postoperative patients
-
recommended
#4
monitoring of postoperative anemia
neutral
postoperative anemia
postoperative patients
-
must be carried out
#5
corrective measures (intravenous iron in particular) or more precise diagnostic assessment
neutral
postoperative anemia
postoperative patients
-
may lead to
#6
restrictive transfusion threshold considering comorbidities and tolerance
neutral
transfusion threshold
postoperative patients
-
recommended
#7
implementation of a strategy and a program for patient blood management
decrease
blood transfusion and length of stay
patients throughout the perioperative period in healthcare establishments
-
recommended to reduce
#8
Abstract

The French National Authority for Health (HAS) recently issued guidelines for patient blood management (PBM) in surgical procedures. These recommendations are based on three usual pillars of PBM: optimizing red cell mass, minimizing blood loss and optimizing anemia tolerance. In the preoperative period, these guidelines recommend detecting anemia and iron deficiency and taking corrective measures well in advance of surgery, when possible, in case of surgery with moderate to high bleeding risk or known preoperative anemia. In the intraoperative period, the use of tranexamic acid and some surgical techniques are recommended to limit bleeding in case of high bleeding risk or in case of hemorrhage, and the use of cell salvage is recommended in some surgeries with a major risk of transfusion. In the postoperative period, the limitation of blood samples is recommended but the monitoring of postoperative anemia must be carried out and may lead to corrective measures (intravenous iron in particular) or more precise diagnostic assessment of this anemia. A "restrictive" transfusion threshold considering comorbidities and, most importantly, the tolerance of the patient is recommended postoperatively. The implementation of a strategy and a program for patient blood management is recommended throughout the perioperative period in healthcare establishments in order to reduce blood transfusion and length of stay. This article presents an English translation of the HAS recommendations and a summary of the rationale underlying these recommendations.

Medical Subject Headings (MeSH)
HumansAnemiaBlood Loss, SurgicalBlood TransfusionFrancePerioperative CareTranexamic Acid
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality90/10
Citation Metrics
Total Citations6
Citations/Year6.0
Relative Citation Ratio2.62
Research Impact Scores
APT Score0.25
Weight Score3.13
Normalized Score0.72
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